Everyone will have low back pain at some point in their life. Many medical professionals consider it a part of being human. The treatment can be costly, and prevention, diagnosis, and treatment options are numerous. The Agency for Health Care Policy and Research (AHCPR), created as a branch of the United States Public Health Service in 1989, recently released guidelines for the treatment of acute low back pain. The guidelines are aimed at decreasing the cost of treatment and streamlining the prevention, diagnosis, and management of low back pain.

In many ways the treatment of back pain today is similar to what you would expect if you were treated for a sore throat 100 years ago. Treatments for a sore throat in 1896 varied from one doctor to another; you might take herbs, poultices, or various tonics. In 1996, treatments for low back pain vary, and any number of treatments may be prescribed for you, including over-the-counter and prescription pain killers, muscle relaxers, anti-inflammatory medications (such as aspirin and ibuprofen), antidepressants, acupuncture, massage, manipulation by chiropractors or physical therapists and various exercise regimens. There are "pain clinics," "back schools," specialized garments, and even the famous special chairs that judge Ito and the defense and prosecution lawyers used at the O.J. Simpson trial! The choices can be as confusing to medical professionals as they are to the public.

The AHCPR guidelines suggest using activity-intensive treatments, such as exercise, instead of expensive medical caring for people who do not have serious medical problems. Passive treatments, such as bed rest, hot packs, massage, ultrasound, and electrical treatments, are not used.

Diagnosing your low back pain
Your doctor will examine you to see if your problem needs to be treated with surgery. Most people do not need surgery to treat their pain. In fact, surgical treatment only works for people who meet strict criteria. If you do not need surgery, your doctor will counsel you about the best program that will enable you to return to your normal activities. By following this program, you should improve from week to week, and nearly all problems should completely resolve within 6 weeks. When appropriate, the doctor refers you to a physical therapist to further evaluate and manage the problem.

An appropriately trained physical therapist can differentiate a muscle strain from a more serious injury to the joints of the spine. Back pain that lasts for more than 2 weeks is usually the result of an injury to one or more of the joints of the spine.

Treatment
A physical therapist with specialized manual therapy skills can isolate and treat joint injuries in the spine. When the joint problem has been successfully treated, strengthening exercises are incorporated into the treatment program. Although you may be in excellent physical condition, your low back may be weak. Your physical therapist can show you special exercises to strengthen your low back muscles (see figure above). Many nerve and disc injuries get better as you exercise. Doing stretches and other exercises for your low back as soon as possible can promote healing of nerve and disc injuries.

Unfortunately, some people do not get better with exercise, but exercising your low back is better than not exercising at all. Moving your back prevents muscle atrophy (withering) and joint stiffness.

Treatment for low back pain varies depending on whether the problem is related to muscles, joints, nerves, or discs. To get the appropriate treatment for your low back pain, the first step is to see your doctor, who will make sure the problem is musculoskeletal and not pain referred from a problem with an internal organ, such as the kidneys. Together, your doctor and physical therapist can treat your pain appropriately using the activity-intensive treatment suggested by the AHCPR guidelines.

Herb Silver, P. T., E. C. S.
Atlanta, Georgia